UNCLASSIFIED As of: 23 Nov 2015 Slide: 1 UNCLASSIFIED U.S. Army Africa Medical Readiness Training Exercise Program (MEDRETE) The overall classification of this brief is: UNCLASSIFIED Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate Presented by LTC Wes Hoyt Deputy Command Surgeon U.S. Army Africa UNCLASSIFIED As of: 23 Nov 2015 Slide: 2 UNCLASSIFIED 4)Takeaways: MEDRETEs train Army personnel; austere & realistic Teams work along side PN providers with only equipment available to PN; facilitates sustainable PN solutions Available US clinical judgment positioned within the AOR MEDRETE : Historically a MEDCOM tool used to train specialty teams in skills or procedures required IOT credential/license in the CONUS (e.g., cataract or cleft palate surgeries). Future MEDRETEs will focus on CCDR effects while training clinical decision making in alternatively resource constrained settings (military medicine) with Partner Nations (PN) IOT simulate expeditionary operations. 3)In FY15 and forward: the purpose of USARAF MEDRETEs will be to achieve CCDR effects and provide military medicine training opportunities for US Army providers/teams to work shoulder to shoulder with PN staff in resource-limited environs IOT simulate medical support to expeditionary operations. 1)FY11-13: USARAF utilized traditional MEDCOM MEDRETEs to train US providers; focus was specialty medicine ; however, MEDRETEs did not train providers to make difficult clinical decisions in resource constrained environments (i.e., military medicine). 2)Starting FY14, USARAF refocused MEDRETEs w/ emphasis on training military medicine; this shifted from using specialty teams from MEDCOM MTFs to trauma-oriented teams from USAREC. MEDRETE: Past, Present, Future Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 3 UNCLASSIFIED USARAF MEDRETEs: Medicine in a Complex World Warfighting Challenges BLUF: Refocusing Medical Readiness Training Exercises (MEDRETEs) on austere expeditionary medical skills is an integral part of maintaining a ready medical force for the U.S. Army. The most important innovative instrument on the battlefield continues to be the Soldier; we must invest in their capabilities. MEDRETEs in Africa provide an exclusive platform for developing clinical decision making and innovation in a resource constrained environment. Current MEDRETEs across the globe do not develop the operational medical skills required to decrease preventable death of casualties in expeditionary and austere environments. A ready medical force, trained in expeditionary environments with constrained resources capable of innovative problem solving providing military medicine Warfighting Challenges ...our vision of the future must drive change to ensure that Army forces are prepared to prevent conflict, shape the security environment, and win wars. Innovation is criticalwe need innovation to ensure that our Soldiers, leaders, and teams are prepared to win in a *complex world. US Army Operating Concept, TRADOC PAM , OCT 2014 *complex - unknown, unknowable and constantly changing. Embedded in host nation facilities Postured surgical contingency response platform Sustained operations beyond traditional 14 days Complex challenges developing innovation Using only host nation equipment Learning shoulder to shoulder with host nation medical teams Bringing the Army Team to Africa Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 4 UNCLASSIFIED Bringing the Army Team to Africa: U.S. Army Africa MEDRETEs, in contrast, serve as a key platform for training a ready medical force, fostering innovation, and strengthening our expeditionary mindset. We embed medical and surgical personnel in host nation facilities using only materiel available to the host nation. U.S. Soldiers work shoulder to shoulder with host nation medical teams to develop clinical judgment in an under-resourced environment. Treating head injuries without CT scans, transfusing whole blood from walking blood banks, and practicing basic field hygiene with burn out latrines and simple hand washing stations using chlorinated water are just a few examples of the wartime skills we can train. The new MEDRETE concept improves regional partnerships and increases bilateral medical professional development. Africa, as the leading leadership laboratory for DoD, provides an ideal venue for developing situational understanding and sustainable skill development for unit level leaders across all Military Occupational Specialties (MOS). Operations and exercises on the continent deliver the unknown, and the unknowable. This complex stage allows us to train how we fight. Funding: USARAF MEDRETEs are funded through Title 10 authorities (USARAF O&M), with additional Title 10 and Title 22 resources leveraged (see MEDRETE examples below). Ultimately the operational budget constrains the expansion of this training program. Additional funds leveraged: Overseas Humanitarian, Disaster Assistance, and Civic Aid (OHDACA) African Peacekeeping Rapid Response Partnership (APRRP) Partnership for Regional East African Counter Terrorism (PREACT) Global Peace Operations Initiative (GPOI) Trans Sahara Counterterrorism Partnership (TSCTP) Sourcing: US training audience is comprised of medical personnel as well as a non-medical C2 element. Each MEDRETE incorporates Soldiers from COMPOs 1 and 3 working together. Future MEDRETEs will include COMPO 2, SOCAF, Joint, and Combined (NATO) partners. Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 5 UNCLASSIFIED Chad USARAF FY16 MEDRETEs MEDRETE 16-1 Who: 3rd MCDS and 7th CSC What: Trauma Resuscitation When: Jan 15; PDSS: 1-4 Sept 15 Where: Senegal Why: Create USARAF operational effects in AOR while enhancing readiness of US Army medical forces. MEDRETE 16-3 Who: ARMEDCOM and 7 th CSC What: Trauma Resuscitation When: 5-21 Apr 2016; PDSS: Jan 15 Where: Chad Why: Create USARAF operational effects in AOR while enhancing readiness of US Army medical forces. MEDRETE 16-2 Who: 30th MED and RAB What: Trauma Resuscitation Where: Ghana : Accra When: 326 Feb 16; PDSS: Oct 15 Why: Create USARAF operational effects in AOR while enhancing readiness of US Army medical forces. MEDRETE 16-5 Who: 44th MED, MEDCOM, and RAB What: FTX / Trauma Resuscitation / General Care Where: Uganda When: 8-30 Aug; MPE: Feb; FPE:16-20 May Why: Create USARAF operational effects in AOR while enhancing readiness of US Army medical forces. Ghana CA16: Gabon, CPX, May 16 EA16: Tanzania, CPX, Mar 16 WA16: Burkina Faso, CPX, TBD 16 SA16: Mozambique, FTX, Aug 16 ACCORD Series Exercises Concept Development Workshop Who: USARAF, MEDCOM, ARMEDCOM, 3 rd MCDS, 30 th MEDBDE, 44 th MEDBDE, NGB, What: Concept Planning Event When: Aug 2015 Where: San Antonio, TX Why: Identify and prepare forces for FY15 MEDRETE events Uganda Gabon = Executed/Executing = No Issues = Additional Coordination Required Senegal MEDRETE 16-4 Who: MEDCOM, 3rd MCDS, and RAB What: FTX / Trauma Resuscitation / General Care Where: Gabon When: 23 May-17 Jun; MPE 7-11 Dec; FPE 7-11 Mar Why: Create USARAF operational effects in AOR while enhancing readiness of US Army medical forces. = Planned Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 6 UNCLASSIFIED USARAF FY16 MEDRETEs Establish U.S. Army Program of Record Builds on foundations / relationships established FY11-FY15 Title 10 USC 401 Humanitarian Civic Assistance exercises Increases HCA consumables expenditure Invites Joint (USN/USMC) Observers or Participants (Senegal, Ghana, and Gabon) Introduces phased model with culminating Combined FTX deploying field medical suite in Gabon and Uganda Mutually supports parallel operations and exercises providing forward surgical capability: WA16, 1206 and SPMAGTF Duration (2) to (4) Weeks Exercises Acquisition Cross Servicing Agreements Introduces Regionally Aligned Brigade to Mission Command Potential ENG Construction in Gabon and/or Ghana Potential to Incorporate/Exercise CSLs Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 7 UNCLASSIFIED Future MEDRETEs Utilizing Alternate Funding and Sources MEDRETE 16-4 Gabon: 23 May-17 Jun 2016 MEDRETE 16-4 will consist of two weeks of clinical pairing followed by a two week FTX that is incorporated into the training objectives of Central Accord 16. U.S. Army medical personnel will partner with U.S. Air Force, Dutch, and Belgian forces for both real-world care and training scenarios in support of African Partner Nations during the FTX. OHDACA $15K (Section 401, Title 10) will be utilized to purchase medical supplies from host nation vendors in support of this MEDRETE. MEDRETE 16-5 Uganda: 8-30 Aug 2016 MEDRETE 16-5 will consist of two weeks of clinical pairing followed by a one week FTX designed to facilitate and incorporate the programs listed below in support of the Ugandans Peoples Defense Force (UPDF). U.S. Army Soldiers will partner with CJTF-HOA, MARFOAF, and the UPDF during the FTX. APRRP $4.6 Mil (Title 22) for medical equipment (deployable Role 2 medical capability). PREACT - $110K (Title 22) for medical training aids - utilized at the Cooperative Training Location (CTL), Singo, Uganda. OHDACA $15K (Section 401, Title 10) will be utilized to purchase medical supplies from host nation vendors in support of this MEDRETE. MEDRETE 17-1 Senegal: Jan 2017 MEDRETE 17-1 will follow the construct of MEDRETE 16-5 (two weeks clinical, one week FTX). However, 17-1 will utilize GPOI funds to support the FTX. U.S. Army Soldiers will partner with MARFOAF, and the Senegalese Armed Forces during the FTX. GPOI - $120K (Title 22) for medical training aids - utilized at the Cooperative Training Location (CTL), Thies, Senegal. OHDACA $15K (Section 401, Title 10) will be utilized to purchase medical supplies from host nation vendors in support of this MEDRETE. MEDRETE 17-3 Chad: Apr 2017 MEDRETE 17-3 will consist of two weeks of clinical pairing followed by a two week FTX that will be coordinated through and funded by SOCAF with TSCTP funds. TSCTP - $55K (Title 22) for medical training and equipping of Chadian combat units preparing to deploy within the Lake Chad Basin. Overseas Humanitarian, Disaster Assistance, and Civic Aid (OHDACA) $15K (Section 401, Title 10) will be utilized to purchase medical supplies from host nation vendors in support of this MEDRETE. Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 8 UNCLASSIFIED Questions / Comments The overall classification of this brief is: UNCLASSIFIED Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 9 UNCLASSIFIED SNAPSHOT MEDRETE 16-1 (Senegal) Status / Issues: Identify Hospital Determine any linkages to CSL Invite USN/USMC AAR Prep MPE Main Body ADVON Media/DV Day Class VIII RDD Ex to COIC Preparation 5 Jan ExecutionDeployment Redeployment 9 to 26 Jan 25 Jan 7 Jan 8 Jan 18 Dec 5 Mar AAR G-3/5/7 CONOP Brief CDE 4 -7 Aug Oct 15 Legal Status: Medical Treatment Protections: TBD Status Protections: TBD Who: 3rd MCDS & 7 th CSC What: Trauma Resuscitation Where: TBD When: 9-20 January 2016 Why: To enhance the readiness of U.S. Army medical professionals, reinforce cooperation between U.S. and Senegalese Defense Forces, and strengthen the capacity of the Senegalese Health Services to perform surgical and trauma response operations. Logistics and Sustainment: Identify if there is an ACSA 28 Dec Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 10 UNCLASSIFIED SNAPSHOT MEDRETE 16-2 (Ghana) Status / Issues: Introduce USN/USMC as Observers Determine any linkages to CSL Invite USN/USMC 2x Weeks at 37th Hospital with follow-on activity in Sekonde Naval Hospital AAR Prep MPE Main Body ADVON Media/DV Day Class VIII RDD Ex to COIC Preparation 10 Feb Execution Deployment Redeployment 14 Mar to 1 Apr 1 Apr 9 Mar 12 Mar 18 Jan 16 5 May AAR G-3/5/7 CONOP Brief CDE 4 -7 Aug Nov 15 Who: MEDCOM & 7 th CSC What: Trauma Resuscitation Where: 37th Military and Sekonde Navy Hospitals When: 14 Mar to 1 Apr 2016 Why: To enhance the readiness of U.S. Army medical professionals, reinforce cooperation between U.S. and Ghanaian Defense Forces, and strengthen the capacity of the Ghanaian Health Services to perform surgical and trauma response operations. Logistics and Sustainment: ACSA and redundant contracting 1 Feb Legal Status: Medical Treatment Protections: ESA Status Protections: No SOFA with the U.S. but accord A&T equivalent status/ AFRICOM waiver NOT required Sekonde Mar 37th Accra Mar Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 11 UNCLASSIFIED SNAPSHOT MEDRETE 16-3 (Chad) Status / Issues: Increased duration in Chad from 2 to 3 weeks based on FY 14 and FY15 AAR AAR Prep MPE Main Body ADVON Media/DV Day Class VIII RDD Ex to COIC Preparation 28 Mar ExecutionDeployment Redeployment 4 to 22 Apr 22 Apr 29 Mar 3 Apr 3 Feb 29 Apr AAR G-3/5/7 CONOP Brief CDE 4 -7 Aug Jan 16 Who: USARC & 7 th CSC What: Trauma Resuscitation Where: Military Training Hospital When: 4 to 22 April 2016 Why: To enhance the readiness of U.S. Army medical professionals, reinforce cooperation between U.S. and Chadian Defense Forces, and strengthen the capacity of the Chadian Health Services to perform surgical and trauma response operations. Logistics and Sustainment: Contracting and GTCC 26 Mar Legal Status: Medical Treatment Protections: MoA Status Protections: SOFA Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 12 UNCLASSIFIED FPE SNAPSHOT MEDRETE 16-4 (Gabon) Status / Issues: Identify Medical Command Incorporate USN/USMC First Field Exercise Mobile Surgical Suite Invite USN/USMC Identify secondary site Potentially incorporate ERC at Loembe Clinic AAR Prep MPE Main Body ADVON Media/DV Day Class VIII RDD Ex to COIC Preparation 16 May Execution Deployment Redeployment 23 May to 17 Jun 16 Jun 18 May 23 May 18 Feb16 22 Jun AAR G-3/5/7 CONOP Brief CDE 4 -7 Aug Dec15 Who: FORSCOM & 3/2 ID What: Trauma Resuscitation Where: Military Training Hospital and Loembe When: 25 May to 16 Jun 2016 Why: To enhance the readiness of U.S. Army medical professionals, reinforce cooperation between U.S. and Gabonese Defense Forces, and strengthen the capacity of the Gabonese Health Services to perform surgical and trauma response operations. Logistics and Sustainment: ACSA and redundant contracting 1 May FTXHospital 25 May 9 Jun 7-11 Mar Jun Legal Status: Medical Treatment Protections: ESA Status Protections: A&T Protections only. NO USAFRICOM waiver required Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate UNCLASSIFIED As of: 23 Nov 2015 Slide: 13 UNCLASSIFIED FPE SNAPSHOT MEDRETE 16-5 (Uganda) Status / Issues: Field Exercise Mobile Surgical Suite Incorporate CSL AAR Prep MPE Main Body ADVON Media/DV Day Class VIII RDD Ex to COIC Preparation 2 Aug Execution Deployment Redeployment 8 to 26 Aug Aug 3 Aug 6 Aug 14 Apr 1 Sep AAR G-3/5/7 CONOP Brief CDE 4 -7 Aug Feb 16 Who: FORSCOM and 3/2 ID What: Trauma Resuscitation Where: Bombo Military Hospital and Field Site When: 8 to 26 August 2016 Why: To enhance the readiness of U.S. Army medical professionals, reinforce cooperation between U.S. and Ugandan Defense Forces, and strengthen the capacity of the Ugandan Health Services to perform surgical and trauma response operations. Logistics and Sustainment: ACSA and redundant contracting 12 Jul FTXHospital 8-21 Aug May Aug Legal Status: Medical Treatment Protections: ESA Status Protections: A&T Protections with additional access provisions Slide POC: LTC Wesley Hoyt Unit/Section: Surgeon Directorate